Application of a reinforced laryngeal mask airway with drain tube in elderly patient undergoing endoscopic sinus surgery / 中华老年医学杂志

Objective To investigate the safety and efficiency of a reinforced laryngeal mask airway(LMA) with drain tube in elderly patient undergoing endoscopic sinus surgery.Methods Sixty elderly patients were selected and randomly divided into two groups:a reinforced LMA group (group R,n=30)and a reinforced endotracheal tube group(group T,n=30).Observation items include the difficulty degree of device insertion,the time for successful insertion,the number of attempts required for successful insertion,fiberoptic view of glottis,the difficulty degree of gastric tube insertion,oropharyngeal leak pressure(OLP),ventilatory indicators at a certain time,haemodynamics during insertion,the blood stain on the mask were compared between the two group.The postoperative complications 1,6,24 hours after operation were recorded.Results There were no significant differences in general conditions,the successful insertion rate at first attempt,the total success insertion rate,airway quality and the anesthetic drug dosage between the two groups.The insertion time was shorter in group R than in group T [(34.1± 13.0 s)vs (45.4± 15.6 s),t =5.274,P=0.001].The incidence of cough during extubation was less in group R than in group T [0％ (0/30) vs.53.3％(16/30),x2 =21.222,P=0.000].Conclusions The reinforced LMA with drain tube is safe and effective for elderly patients during endoscopic sinus surgery.

Transfection of adeno-associated virus encoding beta-nerve growth factor into endothelial progenitor cells / 中国组织工程研究

BACKGROUND:Nowadays, gene therapy has become a new trend for disease therapy and brought promise for some refractory diseases. Its key is to choose proper cel s, genes and vectors. OBJECTIVE:To use recombinant adeno-associated virus mediatedβ-nerve growth factor (β-NGF) to transfect rat bone marrow-derived endothelial progenitor cel s in vitro, and to investigate the effect ofβ-NGF expression on the proliferation of endothelial progenitor cel s. METHODS:The endothelial progenitor cel s were isolated, cultured and identified from the bone marrow of rats. Empty vector or recombinant adenovirus-associated virus containingβ-NGF gene was transferred into endothelial progenitor cel s. We examined the transfection efficiency by fluorescence expression of green fluorescent protein. Expression ofβ-NGF protein was detected using ELISA, and its effect on the proliferation of endothelial progenitor cel s was determined using MTT method. RESULTS AND CONCLUSION:Rat endothelial progenitor cel s were isolated and cultured successful y in vitro and were identified positive by the function of cel s and immunofluorescence staining. The endothelial progenitor cel s were infected directly by the recombinant adenovirus-associated virus containingβ-NGF gene with an efficiency of 65.3%.β-NGF protein was detected in the culture supernatant of transfected endothelial progenitor cel s, which reached a high level at 10 days after gene transfection. Furthermore, there was noβ-NGF protein in the blank and empty vector groups. After transfection, the proliferative ability of endothelial progenitor cel s was increased, which was significantly higher than the blank and empty vector groups (P0.05). These findings suggest that recombinant adenovirus-associated virus containingβ-NGF gene can be successful y transferred into rat bone marrow-derived endothelial progenitor cel s and promote the proliferation of endothelial progenitor cel s.

A restrospective analysis of adverse events during peri-anesthesia period in patients scheduled for thoracic surgery / 中华麻醉学杂志

From August 2006 to June 2011 among consecutive 18 294 patients underwent thoracic surgery from Shanghai Chest Hospital,41 developed adverse events during peri-anesthesia period and the incidence was 0.224％,and the constituent ratios of the predictable and unpredictable events were 15％ and 85％,respectively.Cardiac arrest and massive hemorrhage were the main clinical manifestation of the adverse events and the constituent ratios were 37％ and 24％,respectively.Among the inducements for adverse events,patient's factor,surgical factor,anesthesia factor,patient-surgery factor,patient-anesthesia factor and patient-surgery-anesthesia factor accounted for 12.2％,48.8％,12.2％,7.3％,7.3％ and 12.2％,respectively.The ratio of death from adverse events was 17％ (7 cases),and among the inducements for adverse events causing death,surgical factor,patient-surgery factor and patient-surgery-anesthesia factor accounted for 43％,43％ and 14％,respectively.The incidence of adverse events was 1.093％ in the patients underwent operation on trachea,which was significantly higher than that in the patients underwent operation on lung (0.223％),mediastinum (0.236％) and esophagus (0.194％).In conclusion,although the adverse events which occurred during peri-anesthesia period in the patients underwent thoracic surgery were rare,they threatened the safety of patients.Surgical factor was not only the main inducement,but also the risk factor for death,and cardiac arrest and massive hemorrhage were the main clinical manifestation of the surgery-related adverse events.For cardiac arrest,as long as it was found in time and treated appropriately,the serious consequences could be avoided.For massive hemorrhage,more attention should be paid due to be the main reason of death,and the prevention depended on the surgeon's improvement of diagnosis and surgery.It was difficult to predict patient-related the adverse events and careful monitoring was required.For the anesthesia-related adverse events,they were mostly due to the poor airway management,so preoperative airway assessment should be strengthened.

Occlusion of atrial septal defect utilizing occluder devise via minimally invasive right chest approach / 上海交通大学学报（医学版）

Objective To evaluate atrial septal defect (ASD) occlusion employing a small right anterior thoracotomy approach. Methods A total of 21 patients with ASD underwent general anesthesia and 2 -3 cm incision was made in the fourth right intercostal space. Utilizing transesophageal or transthoracic echocardiography, the occluder was released using a monotube unit. Results All patients were occluded successfully. No patient required open surgery utilizing extracorporeal circulation. There were no major complications and no evidence of residual atrial shunt. Conclusion ASD occlusion via a minimal surgical incision is safe, less invasive, and has excellent outcomes.

Individualized and quantified rehabilitation training after tenosnture of the digital flexor tendon / 中华物理医学与康复杂志

Objective To evaluate the effect of individualized and quantified rehabilitation exercise after te-nosuture of the digital flexor tendon. Methods One hundred and eighty cases of digital flexor tendon tenosuture were randomly divided into a quantification group and a control group. For the quantification group, the maximal ten-sile strength against rupture (Fmax) was measured during the operation. After splinting, the length of an elastic bandwas measured when there was a 2 mm clearance between the 2 ends of the sutured tendon, and the protective device was then fixed with all its parameters unchanged in the whole study. For the control group, Fmax was not measured and there was no protective device during training. Both groups were subdivided into subgroups A and B according to the daily training frequency. Training frequencies of 3 or 6 times per day were applied to the two subgroups. Results After 3 months of rehabilitation treatment, there was no re-rupture in the quantification group, but 6 cases of re-rup-ture occurred in the control group. 91% of the eases in the quantification group were evaluated as excellent or good, while in the control group 80% of the cases were evaluated as excellent or good. Clinical efficacy was significantly better in the quantification subgroup receiving 6 treatments per day than in any other subgroup. Conclusions Indi-vidualized and quantified rehabilitation exercise can prevent tendon re-rupture after tenosuture. 6 sessions of training per day may be better than 3 sessions per day.